Endoluminal balloon dilatation for pelvi-ureteric junction obstruction in children: an effective alternative to open pyeloplasty.
OBJECTIVE
Pelvi-ureteric junction obstruction (PUJO) is one of the commonest causes of paediatric urinary tract obstruction. Open pyeloplasty has always been the reference standard treatment with variable results. Recently, attention has turned to minimally invasive procedures. We reviewed our 8-year experience with endoluminal balloon dilatation to ascertain whether this procedure is an effective minimally invasive alternative.


METHODS
The hospital databases, case notes, and radiology records of 14 patients who underwent 15 balloon dilatations for PUJO were examined. Patient demographics, clinical presentation, radiological investigations, operative details, morbidity and follow up were noted.


RESULTS
The median age was 10.5 years (range 19 months to 14 years); 33% female and 66% male. Nine primary dilatations, five dilatations following open pyeloplasty, and one re-dilatation were performed. The median stenting time was 44 days (range 1-63 days) and the median in-patient stay was 2 days (range 1-17). There were six minor complications due to blocked stents, misplaced stents, or stents falling out. All patients were followed up at 12 months, and nine had further follow up. The median length of follow up was 44 months (range 22-75). Median diameter of the renal pelvis and MAG3 drainage scores improved from 34 to 16 mm and 4 to 3, respectively, from pre-dilatation to most recent follow up. At the most recent follow up, none of the patients had symptoms attributable to PUJO.


CONCLUSIONS
Our results suggest that, using specialized techniques and a multidisciplinary surgeon-radiologist approach, balloon dilatation can be an effective alternative to open pyeloplasty.
Wilkinson
A Graham
AG
Department of Radiology, Royal Hospital for Sick Children, 9, Sciennes Road, Edinburgh, EH9 1LF, UK. graham.wilkinson@luht.scot.nhs.uk
Rajan
Prabhakar
P
MacKinlay
Gordon A
GA